Overview
Clinical Frame
A patient with new confusion, vomiting, and a rapidly rising INR may be entering acute liver failure even before jaundice is striking.
A patient with new confusion, vomiting, and a rapidly rising INR may be entering acute liver failure even before jaundice is striking. The danger is dynamic: loss of hepatic clearance and synthetic function can progress to hypoglycemia, cerebral edema, shock, kidney injury, and infection over hours. The workup therefore runs beside resuscitation, not ahead of it. The NP should obtain an immediate exposure and medication history, assess airway and neurologic trajectory, check bedside glucose, and contact a transplant centre as soon as the syndrome is suspected. A delayed or staggered acetaminophen ingestion may leave a low serum concentration after substantial injury has occurred; a reassuring number must not overrule the history, aminotransferases, INR, or clinical course. The sections that follow connect those bedside signals to cause-finding, neuroprotection, antidote therapy, and transplant decisions.